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HomeMy WebLinkAbout15629-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-]6447 ; Date November 30, 1987 THIS CERTIFIES that the building CONSTRUCT DORMER ADDITION Locatlon of Property, .. ]165 Shipyard Lane East Marion, New York , House Ho .................. $';'~eet ................... ~l~mle~ I 038 01 13 County Tax Map No. I000 Section ....... Block ......... Lot ............... Subdlv,mon ................... Fried Map No ...... Lot No .......... conforms substantially to the Apphcatlon for Building Permit heretofore Fried in flus office dated January 7, I987 pursuant to wluch Bu,ldmg Permit No 15629 Z January 15, 1987 dated ............. was issued, and conforms to all of the requ,rements of the appl,cable provisions of the law. The occupancy for wluch tlns certificate is issued is ...... DORMER ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The cemficate is issued to WALTER.. & of the aforesaid building. Suffolk County Department of Health Approval PATRICIA SOSNOWSKI .... ~oYn'e;,'~YeY~g~ ~ ........... N/A N841824 UNDERWRITERS CERTIFICATE NO ..................................... PLUMBERS CERTIFICATION DATED: March 30, 1987 - Buridmg Inspector Rev 1/81 FOuwe NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETIIoN OF THE WORK AUTHORIZED) N~ 15629 Z Permission is hereby granted to: · Il ,~' ... ' . .~ .............. .... ........................ ?,~,~.,, ........ ~..,....u..~.~..q.. at premises located at ....LL.~....~'.. ..... .cL~:,~....~..~...~ County Tax Map No. 1000 Section ....... ~...~ .~... Block ....... 0....! ....... Lot No.....)....~. ......... pursuant ,o oppltcation dated ....~...l~x~,~...3 ............ , 19..~...']., and approved by the Building Inspector. Fee $. '~'-~ ' Rev 6/30/80 APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 instructions A This applicat,on must be fdled ~n typewriter OR ~nk, and submitted m~ to the Buddmg Inspec- tor with the follow~qg; for new buildings or new use: 1, Foal survey of property with accurate location of all bulldogs, property lines, streets, and unusual natural or topographic features. 2,Foal approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal}. 3.Approval of electrical mstallet~on from Board of Fire Underwriters 4, Commercial buddmgs, Industrial buddmgs, Multiple Remdences and similar buddmgs and instatla- ttons, a cert~ficate of Code compimnce from the Archttect or Engineer responsible for the butlding. 5.Submit Planning ~oard approval of completed rote plan requirements where applicable. / B. For existmg buddmgs (prior to April 1957), Non-conform~ng uses, or bulldogs and "pre-existing" land uses' 1, Accurate survey ~f p~operty showing all property Hnes, streets, buddings and unusual natural or topographic featufies. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housmg code or safety inspection of buddmgs or premmes, or other pertment mforma- t~on required to prepare a certificate. C. Fees' Addzcions $25.00 1.Cert~f[cateofoccupancv New Dwelling $25.00, Accessory ,$I0.00 Bus~ness $50.00 2. Certificate of occupancy on pre-existmg dweJhng $ 50.00 3. Copy of certlflcate of occupancy $ 5.00, over 5 years $[0.00 .v oant o.o. 20.00 1t-18 5.Upaatecl C.Oo $ 50.00 Date ........................ NewConstructzon ...... Old or Pre-ex~sting Budding ........ Vacant Land ......... ~ .... Location of Property ................ : ......................... Honda No. ~ ~ , Street Owner or Owners of Property . . .~.'~.' ./.'T~..I .~.l ~".. '~...~. ?..~, ¢¥'~,... ,~....1~....'~..0..[~..'.~...~..I i ......... County Tax Map No. lOOOSectlon .............~.'~ Block.. ................. 0 / ..... Lot. /.~.. Subdwm~on ................... FHed Map N~ ......... Lot No ............. Permit No. / ........ Date of Permit /:/ .... ZApphcant ..~.~...~....~..~..~..~, .~l.~.'.~... Health Dept Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ....................... PIannmg Board Approval ..................... Request for Temporary Certificate ................ F)nal Certificate ....................... Fee Submitted $ ........................... Construction on above described building and permit meets all a~,Ohcable cod~and regulations. Apphcant . . . . ................. Rev 10 10-78 TO~N OF $OIfI~HOLD OFFICE OF BUILDING INSPECTOR P C~ BOX 725 TOWN HALL S©U~HOLD, N ¥ 11971 TEL. 765-1802 CERTIFICATION ~ate 3 - 5~0-~ 7' Bulldlng Permlt' NO. Owner (please print) (p!e ~se prlnt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. {plumber'S signature) sworn to before me this Notary Public, , ~Uf/W~-~ THE NEW YORK BOARD OF FIRE UNDERWRITERS .1000663 BUREAU OF ELECTRICITY ~- ~ B6 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTII=IE$ THAT ordy t~e e~ectr~d ~qu~p~nent aa de.r,bed belot~ and i~troduced by t~ applicant named on the above application number ~n the l~rem~ea o~ $osuoweki, Shipyard .La. ~1165, FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS RJRNACE MOTORS DIMMERS S~RVICE DISCONNECT ~A~f~B~RDg; l~6cir,, 12.5 ampe, Z-G.F.C.I. 210 NO OF HILEG C E 2/O Glenn ~ox o13 Laurel lic .f~1227 Th~s certsflcote mu~t not be altered in any manner, return 1o the off~:e of the Board if Incorrect Inspectors may be ~dentd~ed by their credenhois COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER OUNDATION ( 1 st) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because of the following reasons. /_~ An application for certificate of occupancy /is not on file. / /_~- No Underwriters Certificate on file. /~7'~ The check ~s(outdated/~..)~25-- /~/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit ~ 1. ~ ~__~ ~ Z Building Dept. ***/~/~No Plumber Solder Certificate on file. ( all permits lnvolving plumbing being issued after April 1,1984 ) Occupancy or use is unlawful without a of Occupancy. Clear up this matter as soon so that legal action does not have to be taken. Thank you for your prompt attentzon. Certzficate as possible ]65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. REMARKS: FOUNDATION ZND [ ] I,~JLATION FRAMING [,~ FINAL DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND ~INSULATION [ ] FRAMING REMARKS: [ ] FINAL DATE F )lsapploved a/c · .~'h~,., FORM NO 1 · ,'J3, ', .,,, .,~. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N Y 11971 TEL.' 765-1802- lC , 198~7 Perm~tNo./ b~'7.o~C~:~. (Budding lnqpector) APPLICATION FOR BUILDING PERMIT Date ~'1, 7. , 19~. INSTRUCTIONS a This application must be completely filled in by typewriter or iii ink and submitted to the Building Inspector, with ts of plans, accurate plot plan tolscale Fee according to schedule b Plot plan showing location of lot and of buildings on premmes, relationship to adjoining premises or public stree : areas, and giving a detailed des~rlphon of layout of property must be drawn on the diagram which m part of flus appl c The work covered by flus ~pphcahon may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will issued a Building Permit to the apphcant. Such perm tall be kept on the premises available for inspection throughout the work e No building shall be occupied or used in whole or in part for any purpose whatever until a Certfficate of Occupanc tall have been granted by the Bmlding Inspector' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldmg Permit pursuant to tb ufl&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances egulahons, for the construcUom of buildings, addlhons or alterations, or for removal or demohtton, as herein describe, tie applicant agrees to comply with all applicable laws, ordinances, building code, housl~}g code, and~gulahons, and t hnit authorized inspectors on premises and m building for necessary ,ate whether apphcant ~s owner (Signature of applicant, or name, if a corporation) z .... · . , (maxling addre,.ss applxcanO lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ (as on the tax roi1 or latest deed) ~ame of owner of premises apphcant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No .'~--~3 .. Plmnber's License No O Llectrlcian's License No. Other Trade's L~cense No ~ ... Location of land on which proposed work will be done .... House Number Street Hamlet County Tax Map No 1000 Section ~.. Block / . Lo~ Subd~vls~ou ~ (Name) Filed Map No Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy J.~ ~.'lt~ .......... b. Intended use and occupanc, ,3 .~. c-~,~/~q.~'~,~.. 7- ,-~7'~,'d/-.R.,a .7"'~.~.~.~. ¢,,,,/1~'~,o1~,~--~.~..' 3 Nature of work (check which applicable) New Building .. Repmr ...... R~moval ............ Demolition 4 Estimated CostY~ .~./..~.o.o.o.? ................... Fee ~.~dit io~. XS(.. Adteratlon .... . Other Work ......... (Descnptlon) (to be paid on filing this application) ! 5 I f dwelhng, number of dwelhng units ....... Number of dwelhng units on each floor. If garage, number of cars ............ 6 If business, commercml or m~xed occupancy, specify nature and extent of each type of use 7 D~mensmns of existing structures, if any. Front . ,,~g ~ Rear .J. Depth .. Height ... /~. ... NumberofStones... / .... Dmaenslons of same stmctur~ with alterations or additions' Front ~'~ / / Rear ~6 · Depth . .-g.~.~ ..... Height . Number of Stones. 2... ..... 8. Dimensmns of entire new constructmn: Front ~, Y' ' Rear ...'~..t~_. ...... Depth ~-...'%.. tte~ght .'2.' (d'. . . Number of Stones . / ......... 9 Sizeoflot' Front ./..oo' Rear /qo/. Depth /~7..J.-'. 0 Date of Purchase ........... Name of Formqr Owner .............. I Zone or use d~stnct m winchlpremmes are situated .~1,57- .~,~.~/a~d {-P~-~*a4qn-/9~- .. 2 Does proposed construction wolate any zonmglaw, ordinance or regulatmn ..-- .......... 3 Will lot be regraded d[20. ~ . . WdI excess fill be remowed fromm prennses Yes 4 Nan~e of Owner of premises ~ --~c4.5..0o~$/~,. Address//t,$ 5/,/,?,/.,~JZ* k 2/~OPhone No z/22- / ~'0 Name of Architect ~- . . .~ . .. Address . . Phone No .... N0ane of Contractor~."/(' ~.o~q.(.. Cr.2~: . Addiess~¥,9-~/~Xt-~,*~ ~',~: .Phone Not~'~'.4q°' Oo.~. 5 Is this property locat&d withinl00 feet of a tidal wetland9 * Yes .... No .2~.. · If yes, Southold Town Trustees Permzt may be required. ' PLOT DIAGRAM Locate clearly and distinctly all bufldmgs, whether existing or proposed, and mdmate all set-back dmaenslons fron ,roperty hnes Give street and i block number or description according to deed, and show street names and indmate whethe ntenor or corner lot. I FATE OF NEW YORK, . , OUNTYOF ,~c~ .~]/~. .... SS (Name of m&wdual signing contract) 9ave named being duly sworn, deposes and says that he is the apphcan ~om to before me this ...... day of.x O-a~.P~34- ........ Notery Public N.Y. 4766573, olk Te~ ~Jr~ Ma~h 30. (Signature of apphcanl e ~s the O.o.~,q ~ ........................... (Contractor, agent, corporate officer, etc ) f smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file th~ ~phcation; that all statements contained in this application are true to the best of his knowledge and belief; and that th ark will be performed m the manner set forth m the application filed therewith OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY for water distributing of b/pea ~ SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCFED 2/10 of I% LEAD. PLUMBER CERTIFICA T/ON ON LEAD CON~'ENT BEFORE CERTIFICATE OF OCCUPANCY '% If ool~l~'tublno I- usad fo~ waif distributing ~ piping shall be i~ lytel K or L only, SOLDER USED/N WATER SUPPLY SYSTEM CANNOT EXCEED 2/I0 of I~ LEAD. PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY